Publications by authors named "Scott W Harmsen"

6 Publications

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Adenomas of the ampulla of Vater: a comparison of outcomes of operative and endoscopic resections.

J Gastrointest Surg 2014 Sep 11;18(9):1588-96. Epub 2014 Jun 11.

Mayo Clinic, Department of Surgery, West 12A, 200 First Street, SW, Rochester, MN, 55905, USA.

Background: Data comparing operative and endoscopic resection of adenomas of the ampulla of Vater are limited. Our aims were to evaluate and compare the long-term results and outcomes of endoscopic and operative resections of benign tumors of the ampulla of Vater as well as to determine which features of benign periampullary neoplasms would predict recurrence or failure of endoscopic therapy and therefore need for operative treatment.

Methods: Retrospective review of all patients treated for adenomas of ampulla of Vater at our institution from 1994 to 2009.

Results: Over a 15-year span, 180 patients (mean age 59 years) were treated for benign adenomas of the ampulla of Vater with a mean follow-up of 4.4 years. Obstructive jaundice was more common in the operative resection group (p = 0.006). The adenomas were tubular in 83 patients (44%), tubulovillous in 77 (45%) and villous in 20 (11%). Endoscopic resection alone was performed in 130 patients (78%). Operative resection was performed in 50 patients (28%), with pancreatoduodenectomy in 40, transduodenal local resection in 9, and pancreas-sparing total duodenectomy in 1. Nine patients who underwent endoscopic resection initially were endoscopic treatment failures. Fifty-eight percent of endoscopically treated patients required one endoscopic resection, while 58 (42%) required two or more endoscopic resections (range 2-8). Patients who underwent operative resection had larger tumors with a mean size of 3.7 ± 2.8 versus 1.8 ± 1.5 cm in those treated by endoscopic resection (p < 0.001) or intraductal extension (p = 0.02). Intraductal extension and ulceration had no effect on recurrence if completely resected endoscopically (p = 0.41 and p = 0.98, respectively). Postoperative complications occurred in 58% of patients, and post-endoscopic complications in 29% (p < 0.001). Endoscopic resection was associated with a greater than fivefold risk of recurrence than operative resection (p = 0.006); 4% of recurrences had invasive carcinomas. When comparing patients who underwent local resections only (endoscopic and operative), there was no difference in the recurrence rate between endoscopic resection and operative transduodenal resection (32 versus 33%; p = 0.49). The need for two or more endoscopic resections for complete tumor removal was associated with 13-fold greater risk of recurrence (p < 0.001).

Conclusion: There is no significant difference between endoscopic and local operative resections of benign adenomas of ampulla of Vater; recurrences are more common when two or more endoscopic resections are required for complete tumor removal. Appropriate adenomas for endoscopic resection included tumors <3.6 cm that do not extend far enough intraductally (on EUS) to preclude an endoscopic snare ampullectomy.
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http://dx.doi.org/10.1007/s11605-014-2543-zDOI Listing
September 2014

Risk factors for lymphoma in patients with inflammatory bowel disease: a case-control study.

Inflamm Bowel Dis 2013 Jun;19(7):1384-9

Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.

Background: Subgroups of patients with inflammatory bowel disease (IBD) may have an increased risk of developing lymphoma. We sought to identify factors that were associated with lymphoma in patients with IBD.

Methods: Cases and controls were identified through a centralized diagnostic index. We identified 80 adult patients with IBD who developed lymphoma between 1980 and 2009. For each case, 2 controls were matched for subtype of IBD, geographic location, and length of follow-up. Conditional logistical regression was used to assess associations between risk factors and the development of lymphoma.

Results: Sixty patients were males (75%) versus 77 controls (48%). Median age at index date was 59 years for cases and 42 years for controls. Twenty patients (25%) and 23 controls (14%) were receiving immunosuppressive medications at the index date. Four patients (5%) and 6 controls (4%) were receiving anti-tumor necrosis factor α agents at the index date. In multiple variable analysis, age per decade (odds ratio, 1.83; 95% confidence interval, 1.37-2.43), male gender (odds ratio, 4.05; 95% confidence interval, 1.82-9.02) and immunosuppressive exposure at the index date (odds ratio, 4.20; 95% confidence interval, 1.35-13.11) were significantly associated with increased odds of developing lymphoma. Disease severity and use of anti-tumor necrosis factor α agents were not independently associated with developing lymphoma. When testing was performed on patients exposed to immunosuppressive or anti-tumor necrosis factor α medications, Epstein-Barr virus was identified 75% of the time.

Conclusions: In this case-control study, increasing age, male gender, and use of immunosuppressive medications were associated with an increased risk of lymphoma in patients with IBD.
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http://dx.doi.org/10.1097/MIB.0b013e318281325eDOI Listing
June 2013

Are gender, comorbidity, and obesity risk factors for postoperative periprosthetic fractures after primary total hip arthroplasty?

J Arthroplasty 2013 Jan 30;28(1):126-31.e1-2. Epub 2012 Apr 30.

Medicine Service and Center for Surgical Medical Acute Care Research and Transitions (CSMART), Birmingham VA Medical Center, Birmingham, Alabama 35294, USA.

We studied the frequency and patient risk factors for postoperative periprosthetic fractures after primary total hip arthroplasty (THA). With a mean follow-up of 6.3 years, 305 postoperative periprosthetic fractures occurred in 14,065 primary THAs. In multivariable-adjusted Cox regression analyses, female gender (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.17-1.88), Deyo-Charlson comorbidity score of 2 (HR, 1.74 for score of 2; 95% CI, 1.25-2.43) or 3 or higher (HR, 1.71; 95% CI, 1.26-2.32), and American Society of Anesthesiologist class of 2 (HR, 1.84; 95% CI, 0.90-3.76) or 3 (HR, 2.45; 95% CI, 1.18-5.1) or 4 or higher (HR, 2.68; 95% CI, 0.70-10.28) were significantly associated with higher risk/hazard, and cemented implant, with lower hazard (HR, 0.68; 95% CI, 0.54-0.87) of postoperative periprosthetic fractures. Interventions targeted at optimizing comorbidity management may decrease postoperative fractures after THA.
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http://dx.doi.org/10.1016/j.arth.2012.03.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3414633PMC
January 2013

Measurement of disease activity in ulcerative colitis: interobserver agreement and predictors of severity.

Inflamm Bowel Dis 2011 Jun 27;17(6):1257-64. Epub 2010 Sep 27.

Miles & Shirley Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, Minnesota, USA.

Background: Endoscopic evaluation plays a pivotal role in the assessment of treatment response in ulcerative colitis (UC). This study aimed to determine the interobserver agreement (IOA) for assessment of mucosal lesions, and to determine lesions predictive of global assessment of endoscopic severity (GAES).

Methods: Fifty-one UC patients had digital videorecording of their colonoscopic examinations, edited into videoclips representative of five colonic segments (rectum, sigmoid, descending, transverse, ascending/cecum). Seven gastroenterologists specializing in inflammatory bowel disease (IBD) independently and blindly rated individual lesions and endoscopic severity for each segment and globally. Edema, erythema, stricture, loss of haustral folds, rigidity, and pseudopolyps were scored as absent or present while vascular pattern, granularity, ulceration, and bleeding-friability were scored using a predefined severity scale. The GAES was based on a 4-point scale and a 10-cm visual analog scale (VAS). The IOA among raters was estimated using Lin's concordance correlation coefficient (CCC). Strength of agreement was categorized as excellent (0.81-1.00), good (0.61-0.80), moderate (0.41-0.60), and fair (0.21-0.40). Linear regression analysis was used to identify lesions predictive of overall endoscopic severity and develop a scoring system for clinical use.

Results: Granularity, vascular pattern, ulceration, bleeding/friability, and pseudopolyps had good IOA in most segments. There was excellent agreement for VAS and good agreement for GAES and the VAS was significantly associated with GAES (P < 0.001). Granularity, vascular pattern, ulceration, and bleeding-friability were significant predictors of overall endoscopic severity.

Conclusions: Granularity, vascular pattern, ulceration, and bleeding-friability demonstrated good reproducibility and were predictors of the GAES in UC patients.
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http://dx.doi.org/10.1002/ibd.21480DOI Listing
June 2011

Relationships between disease activity and serum and fecal biomarkers in patients with Crohn's disease.

Clin Gastroenterol Hepatol 2008 Nov 17;6(11):1218-24. Epub 2008 Sep 17.

Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Background & Aims: The quantitative relationships between instruments and assays that measure clinical, endoscopic, and biologic disease activity in patients with Crohn's disease are poorly characterized. This study evaluated the correlations between the Crohn's Disease Activity Index (CDAI), the Simple Endoscopic Score for Crohn's Disease (SES-CD), serum high-sensitivity C-reactive protein (hsCRP) (both phenotype and genotype) and interleukin-6 (IL-6), and fecal calprotectin and lactoferrin.

Methods: A total of 164 patients with Crohn's disease undergoing colonoscopy were enrolled. The CDAI and SES-CD scores, serum hsCRP and IL-6, CRP and IL-6 genotypes, and fecal calprotectin and lactoferrin were measured.

Results: There were no significant associations between the CDAI and SES-CD scores (Spearman rank correlation coefficient, 0.15) or between the CDAI scores and the serum concentrations of hsCRP and IL-6, or the fecal concentrations of calprotectin and lactoferrin. In contrast, the serum hsCRP and IL-6 concentrations and the fecal calprotectin and lactoferrin concentrations were significantly higher in patients with more severe endoscopic disease activity (SES-CD score > 7 points) (P < .001 for all comparisons). The CRP 717 mutant homozygote and heterozygote status was associated with significantly lower concentrations of hsCRP (P = .02). There was a trend toward higher hsCRP concentrations in the CRP 286 heterozygous adenine mutant-type mutant genotype, but this did not reach statistical significance.

Conclusions: Serum and fecal biomarker concentrations are associated with endoscopic but not clinical disease activity in patients with Crohn's disease. Stimulated hsCRP concentration is affected significantly by select genetic polymorphisms.
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http://dx.doi.org/10.1016/j.cgh.2008.06.010DOI Listing
November 2008

Intraductal papillary mucinous neoplasms of the pancreas: CT patterns of recurrence and multiobserver performance in detecting recurrent neoplasm after surgical resection.

AJR Am J Roentgenol 2004 Nov;183(5):1367-74

Mayo Medical School, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

Objective: The purposes of our study were to describe the CT appearance of recurrent intraductal papillary mucinous neoplasms of the pancreas after surgical resection and estimate the performance of CT in detecting recurrent neoplasms.

Materials And Methods: A single unblinded reviewer characterized the presence and appearance of recurrent intraductal papillary mucinous neoplasms on 66 CT scans of 17 patients with proven recurrence, noting location and appearance of recurrent neoplasm. These results, described in this article, were summarized in tabular format and shown to three blinded observer. The observers then evaluated one postoperative CT examination from every patient at our institution who underwent surgical removal of intraductal papillary mucinous neoplasms (n = 45) for the presence or absence of local or distant recurrence.

Results: The unblinded reviewer found 11 cases of local recurrence. Extrapancreatic local recurrences tend to have solid components (5/6), tend to be located adjacent to the resection margin (5/6), and may exhibit vascular invasion (2/6). Intrapancreatic neoplasms are usually cystic (4/5). Nine patients had distant metastases. Prospective sensitivity for recurrent tumor ranged from 76% (13/17) to 94% (16/17). Sensitivity for local recurrence ranged from 55% (6/11) to 82% (9/11). Specificity ranged from 79% (22/28) to 96% (27/28). Interobserver agreement for predicting recurrence was moderate to substantial (kappa = 0.51-0.65).

Conclusion: Locally recurrent intraductal papillary mucinous neoplasms of the pancreas tend to be either extrapancreatic and solid at the resection margin or intrapancreatic and cystic. CT can detect most recurrent intraductal papillary mucinous neoplasms of the pancreas with moderate to substantial interobserver agreement.
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http://dx.doi.org/10.2214/ajr.183.5.1831367DOI Listing
November 2004